resusitasi jantung dan paru
TRANSCRIPT
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RESUSITASI JANTUNG DAN PARU (RJP)
TUJUAN :TUJUAN : UNTUK MENGATASI HENTI NAFAS DAN HENTI JANTUNG
• MUNGKIN MASIH DAPAT DITOLONG AGAR TETAP HIDUP• USAHA RJP / CPR
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PENYEBAB :PENYEBAB :
HENTI NAFASHENTI NAFAS
BIASANYA DISERTAI : - BRADIKARDIABIASANYA DISERTAI : - BRADIKARDIA - ASISTOLE- ASISTOLE - FIBRILASI VENTRIKEL- FIBRILASI VENTRIKEL
HENTI JANTUNG :HENTI JANTUNG :
* HIPOKSEMIA* HIPOKSEMIA * GANGGUAN ELEKTROLIT* GANGGUAN ELEKTROLIT * PENYAKIT JANTUNG ( ARITMIA )* PENYAKIT JANTUNG ( ARITMIA ) * PENEKANAN MEKANIK * PENEKANAN MEKANIK
(TENSION PNEUMOTORAKS,(TENSION PNEUMOTORAKS, TAMPONADE TAMPONADE JANTUNG)JANTUNG)
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TINDAKANTINDAKAN
1 ORANG PENOLONG1 ORANG PENOLONG
NAFAS BUATAN : PIJAT JANTUNG LUAR NAFAS BUATAN : PIJAT JANTUNG LUAR
2 : 15 2 : 15
2 ORANG PENOLONG2 ORANG PENOLONG
NAFAS BUATAN : PIJAT JANTUNG LUAR NAFAS BUATAN : PIJAT JANTUNG LUAR
1 : 51 : 5
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A. DEWASA :A. DEWASA : I. TINDAKAN OLEH SATU I. TINDAKAN OLEH SATU ORANG :ORANG :
1.1. PADA KORBAN TIDAK SADAR ( PERIKSA PADA KORBAN TIDAK SADAR ( PERIKSA DENGAN GOYANG -DENGAN GOYANG - GOYANG DAN CUBIT GOYANG DAN CUBIT UNTUK MEMASTIKAN )UNTUK MEMASTIKAN )
2.2. LAKUKAN PERTOLONGAN SEGERA MINTA LAKUKAN PERTOLONGAN SEGERA MINTA BANTUAN.BANTUAN.
3.3. ATUR POSISI KORBAN, TERLENTANGKAN ATUR POSISI KORBAN, TERLENTANGKAN DENGAN CARA LOGROLL / DENGAN CARA LOGROLL / MENGGELINDING, HATI-HATI DENGAN MENGGELINDING, HATI-HATI DENGAN ADANYA PATAH TULANG BELAKANG.ADANYA PATAH TULANG BELAKANG.
4.4. BUKA JALAN NAFAS : HEAD TILT / CHIN BUKA JALAN NAFAS : HEAD TILT / CHIN LIFT / JAW THRUST.LIFT / JAW THRUST.
5.5. LIHAT, DENGAR, RABA NAFAS 3 - 5 LIHAT, DENGAR, RABA NAFAS 3 - 5 DETIK.DETIK.
6.6. BERIKAN NAFAS DUA KALI, PELAN DAN BERIKAN NAFAS DUA KALI, PELAN DAN PENUH PERHATIKAN DADA MENGEMBANG.PENUH PERHATIKAN DADA MENGEMBANG.
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7.7. RABA DENYUT KAROTIS 5 – 10 DETIK.RABA DENYUT KAROTIS 5 – 10 DETIK.8.8. BILA KAROTIS TIDAK TERABA, LAKUKAN PIJAT BILA KAROTIS TIDAK TERABA, LAKUKAN PIJAT
JANTUNG DARI LUAR 15 KALI DALAM WAKTU JANTUNG DARI LUAR 15 KALI DALAM WAKTU 9 9 – 11 DETIK PADA TITIK TUMPU TEKAN JANTUNG, – 11 DETIK PADA TITIK TUMPU TEKAN JANTUNG, TEKAN TULANG DADA 5 cm KE DALAM 80 – 100 TEKAN TULANG DADA 5 cm KE DALAM 80 – 100 KALI PERMENIT.KALI PERMENIT.
9.9. LANJUTKAN PEMBERIAN NAFAS BUATAN TANPA LANJUTKAN PEMBERIAN NAFAS BUATAN TANPA ALAT /ALAT / DENGAN ALAT 2 KALI PELAN DAN DALAM.DENGAN ALAT 2 KALI PELAN DAN DALAM.
10.10. LENGKAPI TIAP SIKLUS DENGAN PERBANDINGAN LENGKAPI TIAP SIKLUS DENGAN PERBANDINGAN DUA NAFAS DIBANDING 15 PIJITAN.DUA NAFAS DIBANDING 15 PIJITAN.
11.11. LAKUKAN EVALUASI TIAP AKHIR SIKLUS KE EMPAT LAKUKAN EVALUASI TIAP AKHIR SIKLUS KE EMPAT ( 5 – 7 DETIK ) NAFAS, DENYUT, KESADARAN DAN ( 5 – 7 DETIK ) NAFAS, DENYUT, KESADARAN DAN REAKSI PUPIL.REAKSI PUPIL.
12.12. BILA NAFAS DAN DENYUT BELUM TERABA, BILA NAFAS DAN DENYUT BELUM TERABA, LANJUTKAN RESUSITASI JANTUNG PARU HINGGA LANJUTKAN RESUSITASI JANTUNG PARU HINGGA KORBAN MEMBAIK ATAU CENDERUNG KORBAN MEMBAIK ATAU CENDERUNG MENINGGAL.MENINGGAL.
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Opening airway using head tilt and chin lift during rescue breathing
Chest must rise
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For adults, the correct chest compression is 1.5 to 2 inches, or 4 to 5 cm
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II. TINDAKAN OLEH DUA PENOLONG II. TINDAKAN OLEH DUA PENOLONG ::
1.1. LANGKAH 1 – 10 DIATAS TETAP DILAKUKAN LANGKAH 1 – 10 DIATAS TETAP DILAKUKAN OLEH PENOLONG PERTAMA HINGGA OLEH PENOLONG PERTAMA HINGGA PENOLONG KEDUA DATANG.PENOLONG KEDUA DATANG.
2.2. SAAT PENOLONG PERTAMA MEMERIKSA SAAT PENOLONG PERTAMA MEMERIKSA DENYUT NADI KAROTIS DAN NAFAS, DENYUT NADI KAROTIS DAN NAFAS, PENOLONG KEDUA MENGAMBIL POSISI UNTUK PENOLONG KEDUA MENGAMBIL POSISI UNTUK MENGGANTIKAN PIJAT JANTUNG.MENGGANTIKAN PIJAT JANTUNG.
3.3. BILA DENYUT NADI BELUM BILA DENYUT NADI BELUM TERABA,PENOLONG SERTA MEMBERIKAN TERABA,PENOLONG SERTA MEMBERIKAN NAFAS BUATAN SATU KALI SECARA PERLAHAN NAFAS BUATAN SATU KALI SECARA PERLAHAN DAN DALAM, DISUSUL PENOLONG KEDUA DAN DALAM, DISUSUL PENOLONG KEDUA MEMBERIKAN PIJAT JANTUNG SEBANYAK 5 MEMBERIKAN PIJAT JANTUNG SEBANYAK 5 KALI.KALI.
4.4. LANJUTKAN SIKLUS PERTOLONGAN DENGAN LANJUTKAN SIKLUS PERTOLONGAN DENGAN PERBANDINGAN : 1 KALI NAFAS BUATAN PERBANDINGAN : 1 KALI NAFAS BUATAN ( OLEH PENOLONG PERTAMA ) DAN 5 KALI ( OLEH PENOLONG PERTAMA ) DAN 5 KALI PIJAT JANTUNG ( OLEH PENOLONG KEDUA ).PIJAT JANTUNG ( OLEH PENOLONG KEDUA ).
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BB. . BAYIBAYI : :
1.1. LETAKKAN PADA POSISI NETRAL.LETAKKAN PADA POSISI NETRAL.2.2. TIUPKAN UDARA NAFAS 2 KALI TIUPKAN UDARA NAFAS 2 KALI
( TANPA ALAT / DENGAN ALAT ).( TANPA ALAT / DENGAN ALAT ).3.3. UNTUK PIJAT JANTUNG,GUNAKAN UNTUK PIJAT JANTUNG,GUNAKAN
PENEKANAN DENGAN 2 JARI PENEKANAN DENGAN 2 JARI TENGAH DAN JARI MANIS DIATAS TENGAH DAN JARI MANIS DIATAS TULANG DADA, 1 JARI DIBAWAH TULANG DADA, 1 JARI DIBAWAH GARIS IMAJINASI ANTARA PUTING GARIS IMAJINASI ANTARA PUTING SUSU.SUSU.
4.4. TEKAN TULANG DADA 1 – 2 cm TEKAN TULANG DADA 1 – 2 cm DENGAN FREKUENSI MINIMUM DENGAN FREKUENSI MINIMUM 100 KALI PER MENIT.100 KALI PER MENIT.
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CC. . ANAKANAK : :
1.1. LETAKKAN PADA POSISI LETAKKAN PADA POSISI NETRAL.NETRAL.
2.2. TIUPKAN UDARA NAFAS 2 KALI TIUPKAN UDARA NAFAS 2 KALI ( TANPA ALAT / DENGAN ALAT ).( TANPA ALAT / DENGAN ALAT ).
3.3. PIJAT JANTUNG DENGAN PIJAT JANTUNG DENGAN MENGGUNAKAN SATU TANGAN MENGGUNAKAN SATU TANGAN DENGAN BERTUMPU PADA DENGAN BERTUMPU PADA TELAPAK TANGAN DIATAS TELAPAK TANGAN DIATAS TULANG DADA, 2 JARI DIATAS TULANG DADA, 2 JARI DIATAS ULU HATI.ULU HATI.
4.4. TEKAN TULANG DADA 1 – 2 cm TEKAN TULANG DADA 1 – 2 cm DENGAN FREKUENSI 80 -100 DENGAN FREKUENSI 80 -100 KALI PERMENIT.KALI PERMENIT.
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Status terminal
Fibrilasi ventrikel primer
Asistol primer
Anoksia alveolar
Asfiksia obstruksi/apnea
Eksanguinasi
Gagal paru
Syok
Gagal otak
Henti sirkulasi
Napas spontan
Sadar
Neurologis normal
.
Napas spontan
Sadar/Stupor
Neurologis defisit
.
Napas spontan
Tidak Sadar
Status vegetatif EEG abn
Apnea .
Tidak Sadar
Mati otak EEG
isoelektrik
Mati panorganik
0 menit
2-3 menit
?
?
?
5-12 menit
5 mt 10 mt 15 mt 20 mt
SIRKULASI PULIH KEMBALI
MATI KLINIS
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First “ A - B - C - D “
Airway:
Open the airway
Breathing:
Provide positive pressure ventilation
Circulation:
Give chest compressions
Defibrilation:
Shock VF/pulseless VT
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Second “ A - B - C - D “
Airway: Establish advanced airway control Perform endotracheal intubation
Breathing: Assess the adequacy of ventilation via endotracheal tube Provide positive-pressure ventilations
Circulation: Obtain IV access to administer fluids and medications Continue CPR Provide rhythm-appropriate cardiovascular pharmacology
Differential Diagnosis: Identify the possible reasons for the arrest. Construct
a differential diagnosis to identify reversible causes that have a specific therapy.
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CPR, ONE RESCUER
On the following screen, you will see an action sequence integrating the basics of CPR. This sequence will help to structure your decision making process during an emergency. It first adresses AIRWAY, then BREATHING, then CIRCULATION, the famous ABC’s of CPR. The first sequence is for ONE resquer; the second sequence is for TWO resquers. CPR with foreign body obstruction, FBO, will be treated in the section dealing with foreign body obstruction.
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Are you OK? Gently shake the Are you OK? Gently shake the
victim.victim.
Establish UNRESPONSIVENESS Establish UNRESPONSIVENESS
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Establish whether victim is responsive if no response, CALL 911
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If NO RESPONSE, call for HELP.
Instruct bystander to dial “911”.
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Open airway using head tilt-chin lift or jaw thrust.
LOOK, LISTEN, FEEL for breathing.
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In unconscious victim, the muscles in the tongue may relax, causing the tongue to block the airway
Head tilt and chin lift may open airway
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If NOT breathing, give two slow, full breaths.
The two breaths should take a full five (5) seconds.
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Opening airway using head tilt and chin lift during rescue breathing
Chest must rise
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LOOK to verify that the chest RISES.
If chest does NOT rise reposition head.
Is a PULSE present?
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Listening for breath sounds, and feeling breath against ear or cheek
Assess whether victim is breathing by looking for chest movement,
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Determine if pulse exists by checking carotid artery located between
neck muscleAdam’s apple and
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If pulse present, give two slow, full breaths.
The two breaths should take a full five (5) seconds.
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Opening airway using head tilt and chin lift during rescue breathing
Chest must rise
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If NO PULSE, give 15 rapid, forceful cardiac compressions. The compressions must take only 10 - 12 seconds to complete!
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Cardiac compression started by locating point two fingers above xyphoid process
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For adults, the correct chest compression is 1.5 to 2 inches, or 4 to 5 cm
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Give TWO slow, full breaths, and verify that the chest rises. Then give 15 more cardiac compressions.
Repeat this cycle two more times for a total of four (4) cycles.
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Opening airway using head tilt and chin lift during rescue breathing
Chest must rise
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For adults, the correct chest compression is 1.5 to 2 inches, or 4 to 5 cm
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Stop and quickly check for breathing and pulse.
IF NO BREATHING AND NO PULSE: Continue CPR until help arrives.
IF PULSE PRESENT BUT NO BREATHING: Begin resque breathing at the rate of 15 breaths per minute. Each breath must take 2 seconds.
IF PULSE PRESENT AND BREATHING: Congratutation! You saved the patient.
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AIRWAY VENTILATION DURING TWO RESCUER CPR
1. Each ventilation requires two (2) seconds
2. Verify that chest rises.
3. Second rescuer is in position for chest compressions.
4. For adults, the sequence is one (1) ventilation for every five (5) compressions.
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CHEST COMPRESSIONS DURING TWO RESCUER CPR
1. Five (5) chest compressions in four (4) seconds.
2. Depress sternum 1 to 2 inches, or 4 to 5 centimeters.
3. Second rescuer is in place for airway ventilation.
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The leader then gives one (1) rescue breath, and the second rescuer follows with five (5) cardiac compressions. This cycle is repeated eight (8) more times for a total of ten (10) cycles.
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Stop and quickly check for breathing and pulse.
• IF NO BREATHING AND NO PULSE: Continue CPR until help arrives.
• IF PULSE PRESENT BUT NO BREATHING: Begin rescue breathing at the rate of 15 breaths per minute. Each breath must take 2 seconds.
• IF PULSE PRESENT AND BREATHING: Congratulation! You saved the patient.
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In summary, during two rescuer CPR, one rescuer assumes the leader role and the second rescuer may do any of the following four tasks:
• Go for help....activate EMS….call 911
• Monitor victim during CPR
• Perform CPR when the leader tires
• Perform two (2) rescuer CPR as described earlier
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Mengakhiri resusitasi
1. Sirkulasi dan ventilasi spontan yang efektif telah timbul
2. RJP diambil alih oleh bertanggung jawab melanjutkan RJP
3. Tidak sadar, pernapasan spontan (-), dilatasi pupil 15-30 menit
4. Asistole selama 30 menit setelah RJP dan obat optimal
5. Stadium terminal suatu penyakit
6. Penolong terlalu lelah
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Hal-hal baru dalam RJPO
Airway :
Jangan neck lift
Cukup jaw thrust & chin lift
Pasang oro / nasopharynx tube
Segera intubasi trachea
Breathing :
Nafas jangan 800-1200 ml
Cukup 2 nafas @ 500-600 ml, dada terangkat
Beri sela ekshalasi
Beri oksigen 100% lebih dini
Circulation :
Pijat jantung lebih cepat, 80-100 x / menit
Usahakan DC-Shock lebih dini
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Hal-hal baru dalam RJPO
Drugs :
Adrenaline 1-1-1 / 3-5’
Atropin 1-1-1 / 3-5’
Na-Bicarb hanya 1 meq/kg dan paling akhir
Fibrilation Rx :
DC-Shock sedini mungkin
Drug-Shock-Drug-Shock
200 -- 200-300 -- 360 Joule
# Early access # Early defibrilation
# Early CPR # Early ALS
nadi carotis (+) > 60 mmHg
nadi radialis (+) > 80 mmHg
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VF / VTnadi carotis tak teraba
A - B - Csampai defibrilator terpasang
200 J -- 200-300 J -- 360 J
VF / VT P E A ASYSTOLE R O S C
A - B - C intubasi, IV line
Adrenaline 1-1-1 mg tiap 3-5’
DC shock 360 J dalam 30-60’’
Obat klas IIa
DC shock 360 J dalam 30-60’’ POLA : obat-DC-obat-DC
Lidocain 1,0 - 1,5 mg/kg tiap 3-5’ sp 3 mg/kg
MgSO4 1-2 gm u/torsades
Procainamide 30mg/min
Na-bicarb 1 meq/kg
Jaga jalan nafas Bantu nafas Obat u/ tek darah, nadi, irama
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Early defibrilation
DC-Shock
Non-Synch Synchronized
Khusus VF/VTtidak ada QRS yang baik
SVT / PVCada QRS yang baik
DC-Shock Discharge
Menunggu gelombang R dikenali
DC-Shock Discharge
Tidak menunggu gelombang R
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A - B - C intubasi, IV line
Adrenaline 1-1-1 mg tiap 3-5’
Obat klas IIa
Na-bicarb u/ hiperkalemia / asidosis / overdose obat Adrenaline 1-3-5 mg selang 3 menit
SINGKIRKAN :
Hipovolemia Hipoksia Hipotermia
Hiperkalemia Tamponade jantung
Tension pneumothorax Emboli paru luas
Infark jantung luas Asidosis Overdose
B-block, Ca-block, Digitalis, Trisiklik
Jika bradikardia Atropin 1-1-1 mg tiap 3-5’
sampai 3 mg
PULSELESS ELECTRICAL ACTIVITYada kompleks ECG tetapi nadi
carotis tak teraba
Electromechanical Dissociation Idioventricular rhythm / escape
Brady-asystolic rhythm
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